Provider First Line Business Practice Location Address:
8007 COUNTY ROAD 6920
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407-5758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-725-0042
Provider Business Practice Location Address Fax Number:
806-793-8736
Provider Enumeration Date:
07/14/2005